Healthcare Provider Details

I. General information

NPI: 1689765554
Provider Name (Legal Business Name): TIMOTHY MCCOWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

2500 NORTH STATE STREET
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax:
Mailing address:
  • Phone: 601-984-2538
  • Fax: 601-815-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC-5990
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number19869
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: